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Semi talon and Trace talon: report of two cases.

R. NEERAJA

ABSTRACT. Background Talon is a relatively rare developmental anomaly characterised by the presence of an accessory cusp-like structure projecting from the cingulum area or cemento-enamel junction of the maxillary or mandibular anterior teeth in both the primary and permanent . It is frequently seen in the permanent laterals. Case report The paper presents two cases of of semi talon and trace talon type.

Key words: Talon cusp; Developmental anomaly; Accessory cusp.

Introduction - Type 2 (semitalon): additional cusp of 1 mm or Talon cusp is the name given to the accessory more but extending less than the distance from the tubercles located on the lingual surfaces of anterior cemento-enamel junction to the incisal edge. It teeth [Gündüz and Celenk, 2008]. The talon cusp may blend with the palatal surface or stand away ( of anterior teeth), is a relatively rare from the rest of the . developmental anomaly characterised by the presence - Type 3 (trace talon): enlarged or prominent of an accessory cusp-like structure projecting from the cingulum and their variations, i.e., conical, bifid, or cingulum area or cement enamel junction of the tubercle-like. Radiographically it may appear maxillary or mandibular anterior teeth in both the typically as V-shaped radiopaque structure, as for primary and permanent dentition. This anomalous true talon and semitalon, or tubercle-like, structure is composed of normal enamel and and originating from the cervical third of the root. either has varying extensions of into it or is A talon cusp may present clinically as an isolated devoid of a pulp horn [Hattab and Hazza, 2001]. entity or in association with other dental anomalies, and The prevalence of talon cusp varies considerably it has been associated with some systemic conditions among populations, ranging from 0.06% to 7.7%. The such as Mohr syndrome (orofacial-digital II), Sturge- permanent dentition is affected more frequently than Weber syndrome (encephalo-trigeminal angiomatosis), the primary dentition [Reddy and Munshi, 1995], and Rubinstein-Taybi syndrome, incontinentia pigmenti the anomaly is more common in males than in females. achromians, and Ellis-van Creveld syndrome. Almost 92% of the affected (taloned) teeth in the This article reports two cases of talons cusp: one permanent dentition have been found in the , affecting three permanent in the maxilla and with the lateral incisors being the most frequently the other bilaterally affecting the permanent maxillary involved (55%) followed by the central incisors (36%) lateral incisors. and the canines [Hattab et al., 1995]. According to the classification of Hattab et al. [1995] it is divided into the following types. Case Report 1 - Type 1 (talon): additional cusp that prominently A 10 year old girl reported to our department with projects from the palatal surface of a primary or the chief complaint of mobility in relation to lower permanent anterior and extends at least half right canine, which interfered with her speech. The the distance from the cemento-enamel junction to patient’s medical history was unremarkable. the incisal edge. Examination of the oral cavity revealed an anomalous cusp-like structure on the palatal surface of maxillary right and left laterals and left central incisors. The Assistant professor, teeth were asymptomatic and the additional cusp did Department of Pedodontics and Preventive , M.R. Ambedkar Dental College, Bangalore, Karnataka, India not interfere with occlusion. Intraoral periapical e-mail: [email protected] radiograph revealed a radiopaque projection confirming it as talon cusp. It was a Semi talon type in NEERAJA R.

relation to the laterals and a trace talon in relation to the left central (Fig. 1).

Case Report 2 A 10 year old boy reported to our department with the chief complaint of decayed tooth. The patient’s medical history was unremarkable. Examination of the oral FIG. 1 - A: palatal view demonstrating talon cusp on the cavity revealed an anomalous cusp-like structure on the right lateral and left central and lateral . palatal surface of the maxillary lateral incisors. B: periapical radiograph showing talon cusp outlined by The teeth were asymptomatic and the additional cusp two white lines representing the enamel. did not interfere with occlusion. Intraoral periapical radiograph revealed a radiopaque projection confirming it as talon cusp. It was a trace talon type (Fig. 2).

Discussion The aetiology of talon cusp is not well understood, but appears to have both genetic and environmental components. Similar to other abnormalities of tooth FIG. 2 - A: palatal view demonstrating talon cusp on the shape, talon cusp originates during the morpho- right and left lateral incisors. differentiation stage of tooth development. It may occur B: periapical radiograph showing talon cusp. as a result of outward folding of inner enamel epithelial cells and transient focal hyperplasia of the peripheral cells of mesenchymal . The talon cusp can to allow deposition of reparative dentin for pulpal occur as an isolated finding or in association with other protection. It is difficult to identify the pulpal dental anomalies such as peg-shaped lateral incisor, configuration of talons cusp on radiograph as the cusp agenesis or impacted canines, mesiodens, complex is superimposed over the affected tooth crown [Gunduz odontomes, megadont, dens evaginatus of posterior and Celenk, 2008]. ]. In both our cases the cusp was teeth, shovel-shaped incisors, and small and asymptomatic and required no treatment. exaggerated Carabelli cusp [Tsai et al., 2003]. Small talon cusps are usually asymptomatic and need no treatment. Large talon cusps may cause Conclusion clinical problems including occlusal interference, As paediatric dentists we should be in a position to displacement of the affected tooth, irritation of the identify this accessory tubercle which is a rare type during speech and mastication, carious lesion and commonly associated with maxillary laterals, and in the developmental grooves that delineate the cusp, be in a position to categorise to which type they fall pulpal necrosis, periapical pathosis, of the into and plan an appropriate treatment in case they opposing tooth and periodontal problems due to interfere with occlusion, hygiene and aesthetics. excessive occlusal forces. Talon cusps also present diagnostic and treatment difficulties. On unerupted tooth, the anomalous cusp can radiographically be References mistaken for a supernumerary tooth or compound Bolan MB, Nunes ACGP, Rocha MJC, Canto GLC. Talon cusp: , leading to unnecessary surgical inter- Report of a case. Quintessence Int 2006; 37:509-514. vention. This diagnostic problem is especially Dankner E, Harari D, Rotstein I. Dens evaginatus of anterior teeth. significant because approximately 90% of all Literature review and radiographic survey of 15,000 teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81(4):472-5. supernumeraries occur in the maxilla and half of these Gündüz K, Çelenk P. Survey of talon cusps in the permanent in the incisor region [Dankner et al., 1996]. dentition of a Turkish population. J Contemp Dent Pract 2008 The developmental grooves at the lateral aspects of July; (9)5:084-091. the anomalous cusps are susceptible to caries. If the Hattab FN, Hazza’a AM. An unusual case of Talon Cusp on grooves are carious, the lesion should be eradicated and Geminated Tooth. J Can Dent Assoc 2001; 67:263-6 . the cavity filled with an appropriate restorative Hattab FN, Yassin OM, al-Nimri KS. Talon cusp - clinical material. In cases of premature contact and occlusal significance and management: case reports. Quintessence Int 1995; 26(2): 115-20. interference the anomalous cusp should be reduced. If Reddy NN, Munshi AK. Talon cusp: report of two cases. the treatment requires the removal of a substantial Quintessence Int 1995;26:49-51. portion of the cusp, then reduction should be gradual Tsai AI, Chang PC. Management of Talon Cusp affecting the and on consecutive visits at six to eight-week intervals primary central incisor: A case Report. Chang Gung Med J 2003;